Healthcare Provider Details

I. General information

NPI: 1619320462
Provider Name (Legal Business Name): STELLA DIAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MILLBURN AVE
MAPLEWOOD NJ
07040-3726
US

IV. Provider business mailing address

14335 59TH CIR E
BRADENTON FL
34211-0741
US

V. Phone/Fax

Practice location:
  • Phone: 201-283-6955
  • Fax: 941-281-2129
Mailing address:
  • Phone: 201-283-6955
  • Fax: 941-281-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00562200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: